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Home My WebLink About8485-zTOWN OF SQUTHOLD BUILDING DEPARTMENT 'TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) :N°. 8~,85 Z lvO~,M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. Examined ...... ...~.. · .~.......?~.....~ .....19.?..~.· Approved ........... .v.....(.( ...... .,~... ...... , 192..~.. Permit INo. OC]../~..~.~..~.,~......~... ............. Disapproved a/c~ .:'. .................... ~-- .............. ............................ " v¼ Application No ................................. INSTRUCTIONS o. This application must be completely filled in by typewriter orJ in ink and submitted in triplicate to the BuildingS' Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to ~chedule. b. Plot plan showing location of lot and of buildings on premises, relationship to ad oining premises or public streets o~k~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this app icatiot~. c. The work covered by this application may not be commenced before issuance of BuiJding Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. Lq APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regu at ons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bui ding code, housing code, and regulations, and to bJ admit authorized inspectors on premises and in buildings for necessary inspections. ...... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~,4 Name of owner of premises ..... ~]~(~d.......~....:.....;~~ ....................................................... Jf applicant is a corporate, signature of duly authorized officer. (Name and title of corporate~officer..~ Builder's License No .... ~.~. ~.~T.. ~ · ' Plumber's License No ................................................. Electrician's License No. Other Trade's License No ............................................... d rkw Ibedo Ma No z x Lot No Location of land on which pr~o~~ P .: ........ .~....'~.~2 ............ ~ .... :L.~. ....... ~ .......... Street and Number ~ ......... ~ ........... ; ....... ~":"~~'~ ........ '~"~": ....... .......... ~ '~SON¢s ~LV ~ ~y~ ~ Munci~i~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: ..... ................. a. Exisiting use and occupancy ........ b. Intended use and occupancy ................................................................... ~~'~ ........ 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work '"'~- '~i~i~'i ........... 4. Estimated Cost .............. /.~.x~.~.: .............................. Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ..... , ...................... If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ...............~/...~....~....f ............................ Rear .......................................... Depth ...~...~..'...~?..../. .............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ Ii. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Nome of Owner of premises ........... ~(~, .~.... ........... Address .~r....,......s..~..~.,~..~...-:. Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM L.ocote clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWIYOI~Ig J (Name of individual signing contrac0 above named. He is the ........... ~:~~ .................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; tha~ all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set foffh in the application filed therewith. Sworn to befoce me this . .UDITH T. BOK~N (S~rei~n6tu of applicant)